Priscilla Gomez
Austin,Tx
Summary
Professional patient services expert prepared for seamless coordination of patient care. Proven ability to enhance patient experiences by managing schedules, verifying insurance, and maintaining accurate records. Valued team collaborator with focus on achieving results and adapting to changing needs. Skilled in communication, organization, and problem-solving.
Overview
19
19
years of professional experience
Work History
Patient Service Coordinator
Austin Regional Clinic
Austin, TX
03.2024 - Current
- Maintained compliance with HIPAA regulations while managing sensitive patient information and documentation.
- Managed sensitive patient data with strict adherence to HIPAA regulations, ensuring privacy and confidentiality at all times.
- Provided patient with after-visit summary and scheduled next appointment to maintain continuous care and facilitate treatment plan.
- Responded effectively to challenging situations involving distressed or dissatisfied patients while maintaining a calm demeanor and positive attitude.
- Collected patient co-pay and issued receipt to confirm payment.
- Scheduled appointments to enter appointment date and time into computerized scheduler.
- Enhanced patient satisfaction by efficiently scheduling appointments and handling registration tasks.
- Called patient to confirm appointment and prepared paperwork prior to visit to expedite check-in process.
- Demonstrated exceptional customer service to foster welcoming and professional environment for patients.
- Contributed to a positive clinic environment by consistently displaying compassion, empathy, and professionalism when interacting with patients.
Claims Processor
Veteran Affair Financial Service Center
Austin, TX
01.2014 - 10.2023
- Serves as a Team Member on the Financial Healthcare Service Fee Basis, Medical Claims Team.
- Utilize Microsoft Office applications to correspond and interface with FSC and its customers.
- Knowledge of medical terminology and medical coding.
- Utilize medical claims processing system which incorporates an Internet authorization application, document processing functionality, optical character recognition (OCR) scanning capability in FBCS and VISTA claims processing software.
- Input and validate medical claims data into the FBCS and VISTA applications.
- Analyze documents for accuracy and authorizations, documents financial transactions to assure a proper audit trail.
- Review documentation authorizing benefits payments. Determine appropriate amount due to recipient.
- Analyze and audit any overpayments and underpayments of claims.
- Examine vouchers, invoices, claims and other payment requests for medical services for authorized patients. Documents must be accurate, provide adequate documentation or citations, and comply with laws and regulations. Justification submitted must be in compliance with Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS) and International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) standards.
- Analyze bulk claims and determines appropriate payment amounts.
Treatment Record Specialist
Coventry Healthcare
10.2011 - 12.2013
- Review Outpatient Authorization Request forms
- Verify member benefits
- Review and research provider status in the network
- Create/Enter referrals in claims system (IDX)
- Notify PCP's of outpatient treatment request
Claims Research Specialist
Coventry Healthcare
10.2007 - 10.2011
- Worked on the QMACs system.
- Data entered and reviewed both UBH Hospital and Physician claims.
- Analyzed resubmitted claims and re-entered if allowable.
- Developed and updated policies and procedures.
- Trained co-workers
- Was a valuable team member for answering processing questions.
- Organized and summarized team meetings.
- Very high and accurate producer.
- Reviewed and resolved escalated complaints
Education
Austin Community College
Austin, TX01-2013
Radiology
Bloom Trail High School
Chicago Heights, IL01-1996
Skills
- HIPAA Training
- OSHA Standards and Precautions Training
- Patient Billing – CMS-1500, UB-04
- Coding – CPT, ICD-9, ICD-10, HCPCS
- Office 2007 – Word, Excel, Medisoft
- Medical Terminology
- Appointment Scheduling
- Data Entry
- Knowledge of Insurance Programs: HMOs, PPOs, Workers’ Comp, TRICARE, Champ VA, Blue Plans, Medicare, Medicaid
- Insurance Verification/Authorization
- Billing Procedures
- Price Validate Claims
- Process Bill of Collections
- Process Underpayments
- Appointment scheduling
- Patient registration
- Insurance verification
- Customer service
- Healthcare systems
- Patient check-in
ADDITIONAL INFORMATION
- Qualifications
- Excellent communication skills.
- Knowledge of the insurance and medical benefits.
- Very self motivated and able to finish duties and tasks independently.
- Ability to use critical thinking and constructive hypothesizing when encountering issues.
- Very fast learner. Very organized.
- Experience with Microsoft Word, Excel, Access, PowerPoint.
- Team Player, work well with others.
- Training and coordinating projects and goal setting experience.
Timeline
Patient Service Coordinator
Austin Regional Clinic
03.2024 - Current
Claims Processor
Veteran Affair Financial Service Center
01.2014 - 10.2023
Treatment Record Specialist
Coventry Healthcare
10.2011 - 12.2013
Claims Research Specialist
Coventry Healthcare
10.2007 - 10.2011
Radiology
Bloom Trail High School
Austin Community College